IMPORTANT INFO: IN ADDITION TO SUBMITTING THIS FORM ONLINE, THIS FORM CAN BE PRINTED AND FAXED TO (212) 937-3923. EXPRESS PHONE QUOTE: Toll Free: 888.ARMofNY (276-6369) - BEST PRICES! - BEST CARRIERS! - GREAT SERVICE! - PAYMENT PLANS!

COVERAGE DEFINITIONS Bodily Injury/Guest Passenger (BI/GP) Pays when an insured person is legally liable for bodily injury or death caused by your vehicle or your operation of most non-owned vehicles. This coverage also pays for your legal defense if you are sued. Property Damage (PD) Pays when an insured person is legally liable for damage to the property of others caused by your vehicle and your operation of most non-owned vehicles. This coverage also pays for your legal defense costs if you are sued. *The first two figures refer to bodily injury liability limits (which is required in New York) and the third figure refers to the property damage liability limit. For example, 25/50/10 means coverage up to $25,000 for each person injured in an accident, up to a maximum of $50,000 for the entire accident, and $10,000 worth of coverage for property damage. Comprehensive and Collision Comprehensive and Collision coverage covers the cost to repair or replace your motorcycle if it is stolen or damaged in an accident, regardless of who is at fault. You select a deductible for each coverage, and once the deductible is met, the insurance company pays for the remaining damage. Under Collision Coverage, your insurance company pays for damage to your vehicle when you collide with another vehicle or object. Under Comprehensive Coverage, your insurance company pays for damage to your vehicle caused by an event other than a collision, such as fire, theft or vandalism.

Online Motorcycle Insurance Quote Form

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Complete the below form to find the lowest rate and best coverage!

GENERAL INFORMATION
Your Name:
Street Address:
City:
State:	NY & NJ ONLY!
Zip Code:
E-Mail (REQUIRED):
Phone:
Fax (optional):
Marital Status: Single Married	Is Spouse Vehicle Operator? Yes No N/A
Homeowner? Yes No
Currently Insured? Yes No
If Not Currently Insured When did Cvg. End?	N/A 0-30 Days 31 Days or More
Motorcycle Group? Yes No	(If yes, list Motorcycle Group below i.e HOG, Cycle USA, Etc.)
Motorcycle Safety Course? Yes No	(If yes, list Motorcycle Course Date below)
Auto Def Driving Course? Yes No	(If yes, list Auto Defensive Driving Date below)
CURRENT MOTORCYCLE COVERAGE Liability Limits:	$25k/50k $50k/100k $100k/300k $250k/500k None

DRIVER INFORMATION
Name:		Birthdate:
Sex (M/F):		# Yrs U.S. Cycle  Licensing:
		# Yrs Total Cycle  Experience:
In order to obtain all available DISCOUNTS, carriers run a low level insurance credit check. By providing Social Security # and Driver's License #, we can obtain the LOWEST RATE AVAILABLE!
Driver 1 Social Security #:		Driver 1 Driver's License #:
- IMPORTANT INFORMATION - To receive an accurate quote, you must provide information regarding the approx. DATE and TYPE of any CLAIMS or TRAFFIC VIOLATIONS within the last 39 MONTHS.
DATE	CLAIM / TRAFFIC VIOLATION TYPE
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street
	SELECT ******SELECT CLAIM TYPE******* At Fault Accident $1,000 or less in damage and no Bodily Injury At Fault Accident/Accident with Bodily Injury $1001 or over Comprehensive Claim $1,000 or Less Comprehensive Claim Over $1,000 Not at Fault Accident *****SELECT VIOLATION TYPE***** Accident Prevention Course Auto Theft/Felony Motor Vehicle Commercial Vehicle Violation Defective Equipment Drag Racing Drive Under Influence/Drive While Intoxicated Driving Under Suspension Failure to Report Accident Failure to Yield False Reporting Fleeing From Police Following Too Close Improper Backing Improper Passing Improper Turn Leaving the Scene License/Credentials Violation Minor Moving Violation No Valid License Open Bottle Operating Without License/Invalid Registration Other Serious Violation Passing a School Bus Permit Unlicensed Operator to Drive Reckless Driving Speeding 15 MPH or Less Speeding 16 MPH or More Speeding With Injury Traffic Device or Sign Vehicular Homicide Without Owner's Consent Wrong Way on a One-Way Street

VEHICLE INFORMATION
Year of vehicle:
Make:
Model:
VIN Number:
Annual Mileage:		Used in business? (Explain, if yes):
CC's:		Miles Driven to Work?
Alarmed?	Y   N
Garaged?	Y   N
Current Motorcycle Value:
Motorcycle Accessories Value:
REQUESTED VEHICLE COVERAGES:
MANDATORY COVERAGE  Please Select One Option: (25/50/10 is the minimum allowed by law)
BI/GP - PD: (See Definitions)	25 / 50 / 10    100 / 300 / 50 50 / 100 / 25  250 / 500 / 100
For  FULL COVERAGE  Please Select a Deductable Below:
Comprehensive & Collision:	NO Coverage $250 Deductible $500 Deductible $1000 Deductible
CURRENT COVERAGE INFORMATION:
Current Ins. Co.:
Expiration Date:
Current Annual Cost:

Comments or Remarks:

Click Button Below When Done OR PRINT AND FAX THIS FORM TO FAX: 212.937.3923 or Call: 888.ARMofNY or 888.276.6369 for an Express Phone Quote!